Artikel
Lateral lumbar interbody fusion without intraoperative neuromonitoring: a single center retrospective study of 170 surgeries
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Autoren
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Sandro Krieg
- Technische Universität München, Klinikum rechts der Isar, München, Deutschland
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Lukas Bobinski
- Umeå Universitätsklinik, Umeå, Schweden
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Bernhard Meyer
- Technische Universität München, Klinikum rechts der Isar, München, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Lateral lumbar (LLIF) and oblique lumbar interbody fusion (OLIF) are frequently used for anterior column stabilization with or without dorsal instrumentation. Although the anatomy is quiet clear, many authors report intraoperative neuromonitoring (IONM) of the lumbar plexus nerves to be mandatory for this approach. Since our experience is different and IONM is an expensive add-on, which is sometimes limited in its resources, the objective of this study was to analyze the outcome of our large cohort of patients who underwent LLIF/OLIF without IONM.
Methods: We report on 170 patients enrolled from 2010 to 2016 who underwent LLIF/OLIF after dorsal instrumentation due to degenerative spine disease. While L4/5 was approached via an OLIF-approach, the segments above were fused via LLIF. LLIF/OLIF-related complication, fusion, and reoperation rate as well as clinical outcome measures were evaluated.
Results: Mean follow-up was 15.7 ± 12 months. For 90.0% of patients, cage implantation by LLIF/OLIF was the first retroperitoneal surgery. A median of 2 cages (range 1 to 5) were implanted per surgery, most commonly in L2/3 and L3/4. Mean length of surgery was 92.0 ± 34.6 min; blood loss was 62.3 ± 56.7 ml. The day after surgery, 3.3% of patients showed a new motor weakness, 1.2% new leg pain, and 2% a new sensory deficit due to surgery. Three months after surgery, 0.9% of patients still showed a surgery-related motor weakness, 0% new leg pain, and 1.0% a persistent sensory deficit due to LLIF/OLIF surgery. There were no cases of surgery-related hematoma, vascular injury, CSF leak, or any other visceral injury.
Conclusion: There are 2 reasons for the low complication rates in this series: 1) in L4/5 an OLIF- rather than a transpsoas approach was used; 2) instead of percutaneous approaches, the incisions and exposure of the psoas muscle where just large enough to visualize potential plexus fibers. In our opinion, supported by these data, the complication rates of the approach used in this cohort are comparable if not superior to previously reported cohorts. IONM therefore appears not to be mandatory for LLIF/OLIF procedures. However, these finding should be validated by prospective, randomized study.
